Home phone: Cell phone: Email: If offered ... Telephone ... my qualifications for employment or service with Boys &
AN EQUAL OPPORTUNITY EMPLOYER
DATE:
PLEASE PRINT AND COMPLETE ALL ITEMS Name (Full - Last, First, MI)
(Must be at least 18 years old to apply)
Position(s) applied for:
What days and times are you available to work:
Address:
City
Home phone:
State
Zip
Email:
Cell phone:
If offered employment, can you prove U.S. citizenship or the legal right to work in the United
States Yes No Have you ever submitted an application for employment or volunteer work with this agency ? Yes No If yes, which location (s)?
Date available for employment?
Have you ever been convicted of a crime? (Exclude misdemeanor convictions for marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated; and misdemeanor convictions for which probation was completed or other wise discharged and the case was dismissed) Yes No If yes, briefly describe the nature of the crime(s), the date and place of convictions(s) and the legal
disposition of the case(s):
The Boys & Girls Clubs of San Marcos will not deny employment to any applicant solely because the person has been convicted of a crime. The Boys & Girls Clubs of San Marcos however, may consider the nature, date and circumstances of the offense as well as whether the offense is relevant to the duties of the position applied for.
EDUCATION High School or GED
Address
City
State
Degree
Subjects Studied
College/University
Address
City
State
Degree
Major
GPA
Business/Technical
Address
City
State
Degree
Major
GPA
Other
Address
City
State
Degree
Major
GPA
INTEREST / SKILLS Please list any skills or interests you feel might aid you in the position for which you have applied: Please list any professional licenses, certificates or permits: Have you previously been employed or as a volunteer with any other Boys & Girls Club organizations? If yes, please indicate dates and which locations:
REFERENCES Please list the names and addresses of three personal references (not relatives or former employers) Name
Company/Address
Business/Profession
Telephone
EMPLOYMENT HISTORY Please give accurate, complete full-time and part-time employment history, including military experience. Start with your most recent employer and then work backwards. Present or Last Position
Name of Company
From: Month/Year
Street Address
City
Duties:
Reason for Leaving:
Starting Salary
Name of Supervisor
State
Name of Company
From: Month/Year
Street Address:
City
Duties:
Reason for Leaving:
Starting Salary
Name of Supervisor
Zip
May we contact your supervisor?
Telephone
Final Salary
Next Previous Position
To: Month/Year
State
To: Month/Year Zip
Telephone
Final Salary
Next Previous Position
Name of Company
From: Month/Year
Street Address:
City
Duties:
Reason for Leaving:
Starting Salary
Name of Supervisor
State
To: Month/Year Zip
Telephone
Final Salary
Next Previous Position
Name of Company
From: Month/Year
Street Address:
City
Duties:
Reason for Leaving:
Starting Salary Final Salary
Name of Supervisor
State
Telephone
To: Month/Year Zip
GENERAL If accepted, what special interests do you have? _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________
Please read carefully, initial each paragraph and sign below __________I authorize the BOYS & GIRLS CLUBS OF SAN MARCOS to investigate all statements in this application and to secure any necessary information from all my employers, references and academic institutions. I hereby release all of those employers, references, academic institutions, and the BOYS & GIRLS CLUBS OF SAN MARCOS from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the BOYS & GIRLS CLUBS OF SAN MARCOS. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials, passing the drug test, background screening, employment references and a mandatory TB screening. __________I further understand that any false or misleading statements will be sufficient cause for rejection of my application if the BOYS & GIRLS CLUBS OF SAN MARCOS has not employed, immediate dismissal if the BOYS & GIRLS CLUBS OF SAN MARCOS has employed me. This sentence is confusing. I also authorize the BOYS & GIRLS CLUBS OF SAN MARCOS to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest and I hereby release the BOYS & GIRLS CLUBS OF SAN MARCOS from any and all liability for its providing this information. __________I understand that nothing in this employment application, in the BOYS & GIRLS CLUBS OF SAN MARCOS’s policy statements or personnel guidelines, or in my communications with any the BOYS & GIRLS CLUBS OF SAN MARCOS official is intended to create an employment contract between the BOYS & GIRLS CLUBS OF SAN MARCOS and me. I also understand that the BOYS & GIRLS CLUBS OF SAN MARCOS has the right to modify its policies without giving me any notice of the changes. I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I understand that no company representative other than the President/CEO has the authority to enter into any agreement to employ me for any specified period of time, or to make any agreement contrary to the foregoing. Except as specifically set forth herein, no other representations have been made to me. I hereby acknowledge that I have read and understand the preceding statements.
SIGNATURE OF APPLICANT___________________________________________ DATE___________________
BOYS & GIRLS CLUBS OF SAN MARCOS INVESTIGATIVE CONSUMER REPORT – DISCLOSURE AND CONSENT I, _____________________________, hereby authorize Boys & Girls Clubs of San Marcos to obtain an investigative consumer report containing information related to my character, general reputation, personal characteristics, mode of living, past employment, education, criminal or police records, including those maintained by both public and private organizations, and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment or service with Boys & Girls Clubs of San Marcos. The report will be obtained from: First Advantage Consumer Center P.O. Box 105292 Atlanta, GA 30348-5292 1-800-321-4473 www.fadv.com I understand that, pursuant to Section 1786.16 of the California Civil Code, I have the right to receive a copy of my consumer report by checking the box below. [ ] I would like to receive a copy of my investigative consumer report. Furthermore, I understand that, pursuant to Section 1786.22 of the California Civil Code, I have the right to contact Verified Person during normal business hours to obtain my file for review and that I may obtain my file as follows: 1. In person at the address listed above. You will need to furnish proper identification prior to receiving your file. You may have someone accompany you and you should inform such person that they will also have to present reasonable identification. If you want Verified Person to disclose to or discuss your information with this third party, you may be required to provide a written statement granting Verified Person permission to do so. 2. By certified mail if you make a written request (and provide proper identification) to have your file sent to a specified address. 3. By telephone, if you have previously made a written request and provided proper identification. I release Boys & Girls Clubs of San Marcos and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. ____________________________________ Signature
____________________________ Date
Full Name________________________________________________________________ (Please print)
First
Middle
Last
